Cost-effectiveness of Alternative Approaches to Hepatitis C Diagnosis and Treatment Initiation for Treatment-naive People Who Inject Drugs in Australia: A Model-based Economic Evaluation.

BACKGROUND

Eliminating hepatitis C virus requires efficient testing and treatment strategies. We evaluated cost-effectiveness of alternative hepatitis C virus diagnosis and treatment initiation approaches for treatment-naive people who inject drugs attending Australian community settings.

METHODS

We compared 7 strategies differing by use of antibody screening, laboratory, and/or point-of-care tests, and point of treatment commencement. Outcomes were treatment initiation and completion. We considered costs from a healthcare sector perspective at a 1-year time horizon. We used decision analytical models parameterized with publicly available estimates.

RESULTS

Standard of care laboratory antibody then RNA testing on separate samples was cheapest but least effective. Laboratory antibody then reflex RNA testing on 1 sample provided higher effectiveness and was the only strategy to reduce average cost per completion ($6141 2023AUD; 95% confidence interval, $3924-$10,382). Combined point-of-care antibody and RNA testing, point-of-care RNA alone, and point-of-care antibody with immediate treatment initiation in turn provided incremental improvements in completion at higher average costs per completion (point estimates: $6976-$11 707AUD). Changes in treatment uptake of at least 16 points were required to achieve equivalence between reflex laboratory and point-of-care strategies. Although treatment of nonviremic individuals contributed to higher costs of point-of-care strategies, reflex laboratory testing remained less costly per completion at generic medication costs.

CONCLUSIONS

Reflex RNA testing was the most efficient strategy and can be implemented within the existing Australian laboratory framework. Point-of-care approaches may provide additional benefit at higher near-term costs. Studies accounting for transmission and disease sequelae are needed to understand cost-effectiveness in the longer term.